WHICH

PROFESSIONAL?

One of the oldest mysteries surrounding back pain is choosing the right healthcare professional. Which professional is the most likely to have the most success? When trying to decide on a healthcare professional, many questions should be considered including the education of the professional, their reputation and experience with back pain, expense, and so on. But the most important questions are:

What can the professional do for the immediate relief of your back pain?

What can the professional do for you over the long hall?

These two aspects of back pain treatment, short-term and long-term relief, seem to be the crux of back therapy.

If you've read this book this far, you probably have a good idea what kind of back pain you have. Throughout this book and in my own medical practice, I constantly emphasize a well-rounded, holistic treatment of back pain. In other words, you should treat not only the symptoms but also the causes of your

Four Weeks to a Better Back

problem. This is the reason I put so much emphasis on exercise, on the strengthening of those muscles that support the back, and on diet and attitude. As I've said many times already, more often than not it is you who determines the results of your back problem.

In this chapter I will discuss briefly the qualifications and modes of treatment for many of the popular but not-so-well-known kinds of healthcare professionals. Before we get started, however, I'd like to say a little about healthcare professionals in general.

Be wary of the professional who claims that his or her mode of therapy is the only way to treat your problem. In other words, stay away from, say, chiropractors who believe that manipulation will solve all of your problems, or surgeons who think all you have to do is hack out the pain.

My statement in the preceding paragraph does not in any way suggest that you seek any other kind of professional than a surgeon when you need an operation. But the surgeon you do select should know and discuss with you the need for all aspects of back treatment. Your goal and the goal of the healthcare professional you choose should be the overall, long-term treatment of your back pain. Even if 100 percent remission isn't possible.

Chiropractors

I have chosen chiropractors to lead off this discussion because this profession is usually one of the first you will consider to treat your back pain. My experience is that many back pain sufferers have a lot of misconceptions about chiropractors and chiropractics in general. The next few paragraphs should help you decide whether chiropractics is right for you.

As you may know, even though chiropractors are called doctors, they are not actually licensed medical practitioners. They cannot perform surgeries or prescribe medication. This does not mean, however, that they are not qualified to treat back pain. As you will see from the following descriptions of healthcare professionals, many practitioners who treat back

Which Professional

Chiropractics

pain are not M.D.s. Some of these professionals are highly successful.

Chiropractors do have a fairly extensive education in the human body. Their study of the human skeleton is quite extensive, as well as their studies in nutrition and body mechanics. Their treatment of back pain, though it does usually involve a fairly well-rounded approach, relies heavily on manipulation of the spine. The theory behind spinal manipulation is that by realigning the backbone, the pressure on the discs, joints, muscles and tendons is relieved, thereby relieving your back pain.

I don't have any particular objections to this theory or to chiropractics. Manipulation does seem to offer some temporary relief to back pain. Where many chiropractors experience a lot of success is by helping their patients develop an effective exercise and nutrition program. Manipulation alone does not seem to be enough to bring about long-term relief for back pain.

Four Weeks to a Better Back

Osteopathic Physicians

Like chiropractors, osteopaths rely heavily on manipulation. Unlike chiropractors, this profession can also prescribe medicine and perform other medical procedures such as surgeries. The difference between osteopaths and regular physicians is that the former believe that manipulation can correct "structural derangements" that cause diseases and ailments.

Many osteopaths rely heavily on manipulation and drugs, which, as you have probably already guessed, is not a well-rounded back pain treatment program.

General Practitioners

Often, a knowledgeable general practitioner or family doctor is all you'll ever need for treatment of back pain. A "G.P." as they are often called, is, of course, a medical doctorthe kind you call for most ailments. Even though G.P.s are not necessarily back experts, a good one should know that the key to your problem is improved body mechanics, exercise and proper diet and attitude. General practitioners who are aware of back pain dynamics will try this conservative program before referring back pain sufferers to a specialist. They are also capable of prescribing drugs when necessary.

Which Professional

Orthopedic Surgeon

Orthopedics is the specialty of medicine that deals with diseases and injuries of the locomotor system and its associated structures, including limbs, bones, muscles, joints, tendons, and ligaments. The term orthopedics, which literally means "straight children," goes back to the time when the profession was devoted to the treatment and correction of deformities in children, such as, Clubfoot. However, orthopedists now treat both children and adults for a variety of conditions including fractured bones, torn tendons and ligaments, spastic muscles, congenital skeletal deformities, and bone and joint deformities arising from diseases such as arthritis. If your back pain stems from any of the above symptoms, you could benefit from seeing this kind of doctor.

Neurologists

Neurology is the study of the anatomy, physiology, and pathology of the nervous system. A neurologist is a physician who specializes in diseases of the nervous system. The specialty overlaps to a degree the discipline of psychiatry because neurological disorders often produce symptoms of mental disorder. Neurologists can be beneficial in treating back pain brought on by nervous disorders.

Neurosurgeons

This discipline specializes in performing surgeries that involve the nervous system. Because they operate in and around the spinal cord and various

Four Weeks to a Better Back

nerves, neurosurgeons are often called in on back pain cases. Neurosurgeons are also knowledgeable about how nerves in one area of the body affect other areas. This knowledge often aids neurosurgeons in diagnosing exactly where back pain originates, as in cases of sciatica.

Spine Surgeons

While spine surgeon is not a certified medical specialty, yet, it probably will be. Nowadays, many surgeonsprimarily orthopedic surgeons and neurosurgeonsspecialize solely in surgery of the spine to relieve ailments such as degenerative back disorders, fractures, herniated discs, and so on. These treatments include discectomies, laminectomies, spinal bone fusion, and a whole host of procedures, most of which I discuss in the next chapter.

When you need spinal surgery, you really should find a spine surgeon who specializes the specific type of spine procedure. These types of specialists know the regions of the body (spine) they work on often better than others. When you need back surgery, you should consult a spine surgeon. A spine surgeon is often more likely to provide you with better results.

Do yourself a huge favor though, ask the surgeon how many spinal procedures he or she has performed or assisted in. You don't want your surgeon learning their craft on your back.

Minimally Invasive Spine Surgeons

These are spine surgeons who specialize in minimally invasive spine surgery. Until recently, back surgery has been a highly invasive, highly traumatic procedure requiring several weeks, even months of recoveryoften with the surgery itself potentially causing more problems than the original back condition. This is the reason that I have advocated avoiding traumatic spine surgery, if possible, throughout this book.

However, some conditions, such as herniated discs, can now be treated with a new type of surgery we call minimally invasive surgery (another term I use often is microdecompresive endoscopic (arthroscopic) spine surgery), with a tiny incision.

Which Professional

While this method seems like Brave New World or Star Trek, you can see that this procedure is a lot less traumatic than having your back sliced open.

In this example, I am correcting a herniated disc without putting the patient through a highly traumatic spinal surgery or placing him at great risk. He got up afterwards and walked to his car.

Four Weeks to a Better Back

Performed with mini instruments, such as mini graspers, cutters, curettes, endoscopic video imaging cameras, and lasers, this relatively new type of surgery allows surgeons to enter the spinal region without traumatic dissection of the back or neck muscles. There are no transfusions required and often no need for general anesthesia. Recovery periods are as short as a couple of days to a few weeks, with most people returning to normal activities within the first week.

As I write this, there are only a small number of minimally invasive spine surgeons practicing worldwide. To become good at this procedure requires quite a bit of knowledge, hand-eye 3D ability, and diligent practice. And, since this procedure usually involves working in close proximity to the spinal cord and spinal nerves, it requires a steady hand and practice. (For more on this procedure, see Chapter 14, "Percutaneous Microdecompressive Endoscopic (Arthroscopic) Spine Surgery," which covers this exciting new surgery in detail.)

Minimally Invasive procedures are also less expensive than conventional procedures. If your back pain stems from a herniated disc which many doyou should ask your doctor about consulting a minimally invasive spine surgeon. You can also check out the Internet.

Which Professional

Rheumatologists

Rheumatologists are medical doctors who specialize in diagnosing and treating the more than one hundred forms of arthritis and related diseases. Certainly if you have reason to believe that arthritis plays a role in your back condition, perhaps you should consult this specialist.

Physiatrists

Physiatrists are sometimes called Doctor of Physical Medicine, Doctor of Rehabilitative medicine or Physiatrician. Physiatrists are medical doctors who concentrate on rehabilitative medicine through natural meansmovement, water, heat, cold and specific exercises. As you know from previous chapters these kinds of treatment for degenerative back pain are usually effective.

Acupuncturists

Nowadays, many acupuncturists are medical doctors. As you will remember from the previous chapter, acupuncture is a form of medical therapy that involves inserting thin, solid needles into selective sites on the surface of the body. It has been part of Chinese medicine since ancient times. Acupuncture was long in use in immigrant Chinese communities, but Western interest in it did not become widespread until the 1970s, when physicians in the People's Republic of China demonstrated that it could be used to control surgical pain.

The early Chinese postulated a system of energy circulation that predated by many centuries current understanding of blood circulation and the nervous system. They thought that vital life energy flows through a series of pathways, or meridians, 12 on each side of the body. Meridians were said to course through the deep tissues of the body, surfacing occasionally. The areas where the meridians touch the surface were considered useful treatment points for diseases, which were thought to be caused by imbalances in the energy flow. Inserting a

Four Weeks to a Better Back

needle into certain points could increase energy flow, thereby relieving pain or treating diseases.

Acupuncture seems to be affective for treating certain kinds of back pain. Usually, the relief is only temporary.

Herbalists

A practitioner of an ancient form of healthcare in all cultures (such as traditional Chinese, Indian Ayurvedic medicine, and other natural herbal medicine) with dry plants, leaves, roots, and other types of vegetation for their medicinal application in treating various spinal conditions. Some do work well. But be sure to check out the practitioner's track record.

Physical Therapists

Physical therapists are not doctors and usually can not treat a patient without an order from a doctor.

Physical therapy is the field of medical care that uses exercise and such physical agents as heat, cold, ultrasound, water, and massage to treat certain physical disabilities. Among

Physical therapy helps speed up the recovery process.

Which Professional

its objectives are the relief of pain caused by surgery or by medical problems; the improvement of muscle strength and mobility; and the improvement of such basic functions as standing, walking, and grasping in patients who are recovering from debilitating illnesses, accidents, physical handicaps, and surgery. Physical therapy can be a great help in relieving both short- and long-term back pain.

Yoga Instructors

You've seen that stretching and strengthening your body is helpful in relieving back pain. Yoga can be beneficial in this regard. To the extent that stress contributes to back pain (which it often does) yoga can provide relief. The yoga philosophy of never forcing or straining, and of moving in a meditative manner, has obvious value. But yoga philosophy also encompasses the harmony of mind, body and spirita concept often foreign and even laughable to some people.

Yoga can be helpful, but yoga is more a way of life than a treatment for back pain. It can take some time to master.

Massage Therapists

Massage is a great way to relax, which can relieve the short-term symptoms of back pain. If I were to prescribe massage to one of my patients, it would have to part of a well-rounded, long-term treatment program.

Other Professionals

There is a whole list of professionals not mentioned above. Some, such as, say, physical fitness instructors, are more effective than others, such as a podiatrist. If you keep in mind the things you've learned so fara thorough, long-term, well-rounded approach is your best betyou should have no problem finding the right professional for your problem.

Four Weeks to a Better Back

Recently, magnetic therapy has been promoted and used for treatment of spinal problems in the Orient, Europe, and the USA. Currently, magnet belts, pads, and other magnetic devices are used for spinal conditions--with mixed results.

No, I'm not trying to say anything about doctors,

but how'd you like this guy to treat you?